单眼虹膜角膜内皮综合征患者对侧眼的临床表现

The contralateral eye in patients with unilateral iridocorneal endothelial syndrome

目的 了解单眼虹膜角膜内皮 (iridocornealendothelial,ICE)综合征患者对侧眼的临床表现。方法 观察有病历记录的 42例临床确诊为单眼ICE综合征患者对侧眼的临床表现。对其中 1 9例ICE综合征患者对侧眼的屈光状态、眼压、裂隙灯检查、房角镜检查、超声生物显微镜检查结果进行分析。并将 42例中的 35例ICE综合征患者对侧眼的角膜内皮细胞计数结果与 35例年龄匹配的正常人角膜内皮计数进行比较 ,t检验分析两组间角膜内皮细胞密度、六角形细胞比例及细胞大小变异度的差异。结果 在 1 9例ICE综合征患者的对侧眼中 ,88 9%为正视眼或远视眼 ,1例高眼压 ,50 0 %(6/ 1 2 )前房深度 <2 2mm ,3例虹膜萎缩或发育欠佳 ,3例前房角窄Ⅱ～窄Ⅲ和 (或 )前房角粘连关闭 ,2例前房角锥状粘连 ,1例视野检查发现相对旁中心暗点 ,31 6 %病例合并全身性疾病。 35例ICE综合征患者对侧眼的平均角膜内皮细胞密度为 (2 593 4± 432 7)个 /mm2 ,低于正常对照组 (2 784 9± 2 80 6)个 /mm2 ,两者比较差异有显著意义 (t=- 2 43 ,P =0 0 1 9) ;六角形细胞的百分率为 (56 5± 6 4) % ,低于正常对照组的 (58 8± 5 7) % ,两组比较差异无显著意义 (t=- 1 0 0 5 ,P =0 332 ) ;细胞大小变异度为 0 332± 0 0 3 。

Objective To study the clinical characteristics of the contralateral eyes in patients with unilateral iridocorneal endothelial syndrome (ICE). Methods The clinical characteristics were analyzed retrospectively on the contralateral eyes in 42 cases of unilateral ICE. Among them, 19 patients (19 eyes) received examinations of refraction, intraocular pressure (IOP), slit lamp, gonioscopy and ultrasound biomicroscopy. In the 35 cases (35 eyes), the endothelial cell counts of the contralateral eyes were compared with age matched normal controls using t test. Results In the 19 cases of unilateral ICE syndrome, emmetropia or hypermetropia were found in 88.9%, IOP higher than 21 mm Hg was present in one case, and anterior chamber depth lower than 2 2 mm was in 50 0%. Atrophy or dysplasia of iris existed in 3 cases, there were narrowness and/or adhesion of anterior chamber angle in 3 cases and pyramidal adhesion under gonioscopy and/or ultrasound biomicroscopy examination in 2 cases. One case represented relative paracentral scotoma in the visual field examination. Systematic disorders, including hepatitis B, diabetes, hyperthyroidism, duodenum ulceration, hypertension were found in 31 6%. In the 35 patients who received endothelial cell count, the average endothelial cell density of the contralateral eyes was (2 593 4± 432 7)/mm 2, which was significantly lower than that of the normal controls (2 784 9± 280 6)/mm 2( t =-2.43, P = 0 019). The hexagonality and coefficient variation of cell size of ICE patients did not differ from that of the normal controls. Conclusions The contralateral eye in cases diagnosed as unilateral ICE syndrome may be subclinically involved, so it is necessary to pay attention to the contralateral eye, and follow up all the patients suffered from ICE syndrome.